Provider Demographics
NPI:1770892945
Name:DIMAILIG, DONDON (APN)
Entity type:Individual
Prefix:
First Name:DONDON
Middle Name:
Last Name:DIMAILIG
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE STE A-425
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-644-0500
Mailing Address - Fax:702-641-4600
Practice Address - Street 1:2628 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2176
Practice Address - Country:US
Practice Address - Phone:702-644-0500
Practice Address - Fax:702-641-4600
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001185363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDT400YMedicare PIN